In the current decade, video games may have helped kill the way high school football practices are conducted.

"Hydration is a big issue and has been for a while," said Dr. John Greco of The Orthopaedic Center, and the North Alabama medical adviser for the Alabama High School Athletic Association.

"So many of the athletes now playing are playing Xbox instead of going out and playing. They're staying in air conditioning instead of going out and playing, so we're seeing a lot more emphasis on hydration."

Water is readily available at high school practices, something akin to heresy not long ago when a break mid-practice might be the only opportunity to get more than a bottle-squeeze.

Not today. Teams not only have ample water circulating during practice but have it running cold and readily available on sidelines. The AHSAA allows only one full-pads practice during two-a-days when heat cautions are issued.

And players have someone watching over them.

"I'll look at the schedule, check the heat and ask the coach, 'Can we take five extra minutes (during breaks) and take the pads off and, if not, can we have more breaks?'" said Michael Stevenson, a Huntsville Hospital athletic trainer who recently moved from Butler High to Huntsville High.

Huntsville Hospital and SportsMed provide athletic trainers, not just "gym trainers," Stevenson said, to all local high schools.

"As far as I know, the region is unique in that all the Huntsville/Madison County area schools have an athletic trainer who is nationally certified and state licensed with at least a four-year college degree," said Marco Cazzavillan of SportsMed, who serves as Buckhorn High's athletic trainer. "Some even have master's degrees in the field or a related field."

Stevenson agreed the area is unique in that most schools, including most within The Times' coverage area, have athletic trainers whose job it is to cover one school.

"South of Birmingham,'' he said, "a lot of the schools don't have the same access."

Concussion concerns

Heat illness moved into the headlines earlier this month when heat was suspected, but not yet proven, in the deaths of three high school players - two in Georgia, one in South Carolina.

But as the heat subsides and cooler weather arrives, concussions will again be the major topic of concern. Last season, the AHSAA broke ground among national associations with rules making it harder for a player suspected of having a concussion to return to the field.

Alabama Gov. Robert Bentley has since signed legislation backing the AHSAA's move.

"Part of what Governor Bentley was signing in was that if there's not a physician on either side, then the referee has to take control and keep the player out," Greco said. "That's their mandate. Either a medical doctor makes the decision or the head referee makes that call."

That's another step away from the previous way of doing things.

"It used to be when you were playing football and you got your bell rung a little bit, you're like 'Let's shake the cobwebs out, how do you feel?' " Greco said. "If the player didn't have a headache, they'd have him count numbers back and/or give him words to remember, see if he can remember them after halftime. Then, they let him go back.

"Now, when you get your bell rung, no matter how little, technically you are out of that game."

Death rates up

Despite efforts to hydrate players, Andrew Grundstein of the University of Georgia reports the annual death rate from heat illness has increased from an average of about one per year in the 1980s to a 2.8 yearly average in the last 15 years, possibly due to higher annual temperatures and bigger players.

That rate might come down if Douglas Casa, who heads the Kory Stringer Institute and edited "Preventing Sudden Death in Sport and Physical Activity," has his way. He suggested that not having athletic trainers at high school football practices and games "should scare ... any parent in America."

For local athletes and parents, that's not the case.

"It's impossible to quantify the number of catastrophes that have been averted due to the presence of these athletic trainers at our local sporting events," Cazzavillan said. "I feel that the reason for this is that both Huntsville Hospital and my employer, SportsMed, provide professional, well-trained, dedicated athletic trainers to the area high schools and colleges."